Sherif Hakky

The use of multimedia consent programs for surgical procedures: a systematic review.

Objective. To compare multimedia and standard consent, in respect to patient comprehension, anxiety, and satisfaction, for various surgical/interventional procedures. Data sources. Electronic searches of PubMed, MEDLINE, Ovid, Embase, and Google Scholar were performed. Relevant articles were assessed by 2 independent reviewers. Study selection. Comparative (randomized and nonrandomized control trials) studies of multimedia and standard consent for a variety of surgical/interventional procedures were included. Studies had to report on at least one of the outcome measures. Data extraction. Studies were reviewed by 2 independent investigators. The first investigator extracted all relevant data, and consensus of each extraction was performed by a second investigator to verify the data. Conclusion. Overall, this review suggests that the use of multimedia as an adjunct to conventional consent appears to improve patient comprehension. Multimedia leads to high patient satisfaction in terms of feasibility, ease of use, and availability of information. There is no conclusive evidence demonstrating a significant reduction in preoperative anxiety.

The effect of bariatric surgery on echocardiographic indices: a review of the literature

Obesity is the new epidemic and is associated with an increased risk of diastolic and systolic heart failure. Effective treatment options with drastic results such as bariatric surgery have raised interest in the possible reversal of some of the cardiovascular sequelae. Many studies have assessed individually the effect of weight loss on specific echocardiographic indices, mostly employing nonhomogeneous groups. The purpose of this narrative review is to summarise the effect of bariatric surgery on echocardiographic indices of biventricular function and to help in the understanding of the expected echocardiographic changes in bariatric patients after weight‐loss surgery

Erratum to: An Endoscopic Strategy Combining Mega Stents and Over-The-Scope Clips for the Management of Post-Bariatric Surgery Leaks and Fistulas (with video).

Background and Aims Endoscopic stenting has proved effective in the management of post-surgical leaks but is strongly hampered by the high rate of stent migration. In this study, we evaluate our experience with a new approach involving the use of novel ultra-large expandable stents tailored for bariatric surgery leaks (Mega stents), combined with the use of the innovative over-the-scope clips (OTSC).

Ventricular remodelling post-bariatric surgery: is the type of surgery relevant? A prospective study with 3D speckle tracking

AIMS The aim of the study was to examine ventricular remodelling in patients free of cardiac risk factors, before, and 6 months post-bariatric surgery with the new imaging modality of three-dimensional (3D) strain and the comparison of two surgical techniques: sleeve gastrectomy vs. gastric bypass. METHODS AND RESULTS Fifty-two consecutive patients referred to the Bariatric Services of Imperial College NHS Trust were examined with conventional 2D and 3D strain echocardiography, prior to and 6 months after bariatric surgery. They were all free from cardiac disease. The study cohorts mean age was 44.2 ± 8.7 years and body mass index of 42.4 ± 4.6 g/m(2) prior to surgery. Eighteen patients (34.6%) underwent laparoscopic sleeve gastrectomy, and 34 laparoscopic gastric bypass. On 3D speckle tracking, there was significant reverse remodelling post-bariatric surgery [left ventricular (LV) ejection fraction (EF): pre-surgery: 59 ± 8% vs. post-surgery: 67 ± 7%, P < 0.001 and right ventricular (RV) EF: pre-surgery: 60 ± 9% vs. post-surgery: 68 ± 8.2%, P = 0.0001]. Furthermore, there was significant regression of mass (LV mass: pre-surgery: 111 ± 23.5 g vs. post-surgery: 92.8 ± 15.5 g and RV mass: pre-surgery: 95.2 ± 19.8 vs. post-surgery: 67.3 ± 16.3, P < 0.001). RV and LV global strain improved 6 months post-bariatric surgery: global RV strain: pre-surgery -11.7 ± 4 vs. post-surgery -17.52 ± 3.7, P < 0.001; global LV strain: pre-surgery: -20.2 ± 1.7 vs. post-surgery: -26.5 ± 1.86, P < 0.001. Sleeve gastrectomy and gastric bypass had comparable effects. CONCLUSION Bariatric surgery has an important effect in reverse LV and RV remodelling and it substantially improves RV longitudinal strain.

Systematic review on citation classics in minimally invasive gastrointestinal surgery

Background: The impact an article has on a specific field is manifested by its number of citations. The aim of this systematic review was to perform a citation analysis and identify the 100 most-cited articles in the field of minimally invasive (MI) gastrointestinal (GI) surgery. Methods: The Institute for Scientific Information Web of Knowledge (1945–2017) was utilised to identify the top 100 most-cited articles in the field of MI GI surgery, using 19 distinct keywords. The data extracted were number of citations, time of publication, research topic, level of evidence, authorship and country of origin. Results: Of the 100 most-cited articles, the number of citations ranged from 3331 to 317 citations. Most publications reported on bariatric surgery (n = 36), followed by oncology (n = 26) and hepatobiliary surgery (n = 15). The studies were published in 26 different journals with the top three journals being Annals of Surgery (n = 30), New England Journal of Medicine (n = 10) and Obesity Surgery (n = 9). The studies were conducted in 17 different countries led by the USA (n = 51), the UK (n = 9) and France (n = 6). Articles were published on all levels of evidence: level I (n = 20), Level II (n = 29), Level III (n = 8), Level IV (n = 29) and Level V (n = 14). Conclusion: The study revealed citation classics in the field of MI surgery. Interestingly, a high level of evidence was not significantly associated with an increased citation number.

Gallbladder perforation into the greater omentum following sleeve gastrectomy: A case report study

Highlights • Bariatric surgery increases the risk of complicated cholecystitis.• The first documented case of a gallstone that was half-eroded into the greater omentum following sleeve gastrectomy.• A concomitant cholecystectomy should be performed for patients with symptomatic cholelithiasis, underging sleeve gastrectomy.• A Subsequent cholecystectomy is associated with increased surgical technical difficulties.

109 LEFT VENTRICULAR REMODELLING IN BARIATRIC PATIENTS: STUDY WITH 4D ECHOCARDIOGRAPHY AND STRAIN

Purpose The aim of this study was to examine left ventricular (LV) echocardiographic indices, 4D volumes and ejection fraction of bariatric patients (BMI >40). Methods Forty-nine consecutive normotensive bariatric patients (31 women (63.2%), 43 Caucasian, mean age: 45.7±9.7 years, BMI ≥40 kg/m2) were examined with 3D and speckle tracking echocardiography pre-bariatric surgery and they were compared with an age-matched group of 30 healthy volunteers. Exclusion criteria were coronary artery disease, cardiomyopathies and arrhythmias. Statistical analysis was performed with SPSS V.14.0 and Medcalc softwares. All indices were indexed to body surface area and heart rate, where appropriate. Results Common comorbidities comprised diabetes mellitus (N=7), fatty liver (N=8), hypertension (N=8) and sleep apnoea (N=12). 2D echocardiography demonstrated dilatation of the left atrium in bariatric patients when compared to healthy volunteers (39.2±1.9 vs 32.3±2.6 mm, p<0.01); LV end-diastolic diameter was increased (49.2±4.8 vs 42.9±3 mm). 4D values demonstrated an increase in LV end-diastolic volume (182.5±47.7 vs 116.1±15.9 ml); LV ejection fraction was preserved, however lower when compared to healthy volunteers (57.8±7.4 vs 68.4±5.9%). LV mass was also greater in bariatric patients (107.5±28 vs 84.7±11.6 grs). When performing strain with Echopac, there was a contraction delay of global strain in bariatric patients when compared to healthy volunteers (p<0.05). Conclusions Bariatric patients demonstrate increase of LV mass, dilatation of the ventricle and signs of diastolic heart failure with preserved ejection fraction.

The case of being in the wrong place at the wrong time: the consequences of undiagnosed anatomic anomalies.

The case of being in the wrong place at the wrong time: the consequences of undiagnosed anatomic anomalies Susannah M. Wyles, M.Sc., M.R.C.S.*, Sherif Hakky, M.Sc., M.R.C.S., Ahmed R. Ahmed, B.Sc., F.R.C.S.(Gen.) Department of Bariatric Surgery, Imperial College Weight Centre, Imperial College Healthcare National Health Service Trust, London, United Kingdom Received April 29, 2011; accepted May 7, 2011